Managing a pandemic: New book from Michael Dowling, health system CEO

“It’s been a little hectic,” said Michael Dowling, CEO of Northwell Health System, understating the turbulent months at the height of the COVID-19 coronavirus pandemic.

The hospital system, with 23 facilities in the Greater New York area, had the most COVID cases of any system in the United States: 77,000. But Mr. Dowling doesn’t come across as someone who would scare easily.

“It’s my personality. I get calm in a crisis and try to stay positive,” he told the Reporter. Still, he described scenes that were terribly stressful as he visited every hospital, every day. “At North Shore-LIJ, we had between 500 and 700 COVID patients, but as I walked the floor, it was eerily quiet.”

All of the patients were on ventilators, and no visitors were permitted, so the sounds of voices were absent. “It was just the sound of the nurses and doctors shuffling from patient to patient,” he said. And although they were able to save thousands of lives, he knew, with some 90 deaths a day, that at least half of those silent patients were not going to survive.

He recently published a book, “Leading Through a Pandemic,” co-authored with journalist Charles Kenney, is a chronicle of the experiences of the past several months and offers a roadmap for facing future crises.

Growing up in Limerick, Ireland, Mr. Dowling played hurling, and earned his undergraduate degree from University College Cork. He has a masters from Fordham University, where he served in the faculty and administration, before going on to work in state government. He served as Gov. Mario Cuomo’s director of Health, Education and Human Services and Commissioner of Social Services. It wasn’t a surprise when the current governor, Andrew Cuomo, called on him to help the state respond to the pandemic.

Mr. Dowling gives Mr. Cuomo credit for keeping New Yorkers informed of facts as COVID-19 cases peaked in New York, providing daily briefings until the numbers were finally brought down. Also critically important, he said, was that the governor waived hundreds of rules, including one regarding “licensure,” for example, so that critically needed medical staff could be brought in from other states.

Mr. Dowling minces no words when it comes to the response of the federal government, which he calls “a complete and total disaster.”

As the wave crested in New York, the Javits Convention Center was converted to a COVID hospital, which Mr. Dowling oversaw. When the naval ship Comfort sailed into New York Harbor, many hailed the prospect that more relief was at hand. But when its command initially refused to take COVID patients, Mr. Dowling was furious. “It’s a joke,” he said publicly with his typical bluntness.

Admirals pushed back at Mr. Dowling, who argued that he had nothing but COVID patients. Eventually the Comfort provided some help, but not on the scale that was envisioned.

Northwell was well-positioned to confront the pandemic in Greater New York, with hospitals from Westchester to Staten Island, Manhattan to the East End, served by Peconic Bay Medical Center in Riverhead.

In addition to its enormous scale, the system had begun planning for a major crisis even before the September 11, 2001 attacks. Located near three major airports, JFK, LaGuardia and Newark, the system was likely to be called upon in the event of a major attack or emergency. The system had established an “all-hazards” approach, since a crisis could be anything from a terrorist attack to extreme weather events to infectious diseases. Millions of dollars were invested in equipment as well as hiring emergency management experts and providing training for their thousands of staff. Their goal was to be “comfortable with being uncomfortable.” Having prepared as well as possible, one lesson offered in the book was, “In a crisis, throw the budget out the window. Deal with it later.”

The book is designed to guide other health systems through future challenges, which Mr. Dowling said are sure to follow. “Pandemics will be inevitable and come with more frequency,” he said. “As a state and a country we have to be better prepared. This is a war.”

Northwell’s most heavily impacted area was around the Queens-Nassau border, in the area served by North Shore-LIJ Hospital. What the system needed was “load-balancing,” Mr. Dowling explained. When one hospital’s capacity was exceeded, they activated a plan to move patients elsewhere in the system. Many of them were transferred to Peconic Bay Medical Center.

“It says something special about the staff at Peconic Bay,” Mr. Dowling said, “Without hesitation they took patients from other hospitals and cared for them, while taking care of the local people at the same time.” 

Typically, upon discharge from a hospital, a patient is responsible for his or her own transportation. But patients who’d walked into a hospital in the city could wake up two weeks later in Riverhead, possibly 60 to 90 miles from their home. Once patients recovered, Northwell transported them back to their homes, wherever they’d come from, using the system’s own fleet of ambulances.

The book quotes several members of the Northwell administration and staff, taking a look back at what was done well and what could be improved. Chief Nursing Executive Maureen White said, “We could have done better preparing nurses for the landslide of very sick patients.” The system has 17,000 nurses, who are described in the book as “the tip of the spear — like Marines in a war.”

The numbers were staggering. “We had 70 patients around St. Patrick’s Day,” Mr. Dowling recalled. By April 6, they had 3,500. “And it just exploded after that.”

Eventually the system doubled its capacity of 3,000 beds. To accommodate the wave of patients, major adjustments were made. The leadership of Katz Women’s Hospital, a dedicated obstetrics facility, turned their hospital over for COVID care and moved mothers and babies to an ambulatory surgery center, safely away from the virus.

A 250-seat auditorium was transformed overnight, with the hospital’s carpenters, engineers, electricians and plumbers unbolting and removing the seats, constructing walls and screens between beds.

Recently, with New York’s infection rate reduced, the governor created an initiative to bring leaders together to re-imagine the future of the state post-COVID. The Gates Foundation, Michael Bloomberg and former Google CEO Eric Schmidt were asked to serve, as was Michael Dowling — specifically to help re-imagine the future of health care delivery in New York.

In the book, Northwell staff share their stories of the human toll. Environmental Service worker John Baez travels three hours each way from his home in Yonkers to work at Staten Island University Hospital. He recalled a day when he learned that a patient was soon going to die without her family beside her, like thousands of other COVID victims. His shift was over, but he couldn’t leave her. Having met her days before, he told her he was there with her, holding her hand and praying as she drew her last breaths.

“I took the two buses and three trains home,” he wrote, “replaying the day in my head. It’s always going to be with me, the sadness that she couldn’t have a loved one with her, but I couldn’t let her die alone.”